What is Infant Reflux?
Infant Reflux is a condition where the contents of the stomach pass into the oesophagus. This may then be swallowed back down (as in silent reflux), pass into the mouth (regurgitation) or be ejected from the mouth (vomiting).
Up to 70% of babies regurgitate some stomach contents into their mouth at least once daily. It is a normal occurrence and can be due, in part, to the frequency and size of a baby’s feeds.Remember a baby’s weight can triple in the first year of life and this growth requires constant feeding!
Reflux becomes an issue however when there are associated symptoms that cause distress. This is then called Gastro Oesophageal Reflux Disease (GORD)
General Signs and Symptoms of most cases of Infant Reflux.
- Crying and irritability for longer than 3 hours a day. This can be at any time of the day or night or at a specific time every day.
- Regurgitation or vomiting of milk and/or clear fluid.
- Arching when feeding or after feeding.
- Wheezing on an ongoing basis.
- A noticeable breath change where baby inhales and makes a stridor type of sound.
- Nasal congestion.
- Hiccups after most feeds.
- Baby seems to be in constant motion.
- Baby is very dependent on the upright position. Any change to a more horizontal position will not be tolerated well.
It’s important to remember that baby will not have all these symptoms. This is a guide to help you recognise the general symptoms of reflux so that you can give your Health Practitioner as much information as possible.
Management of Infant Reflux
- Keep baby in an upright position if possible during feeds and for at least 30-40 minutes afterwards. Some babies will also prefer this upright position between feeds.
- Gently wind baby frequently during the feed.
- Do not over feed baby.
- Gentle movement in a sling or buggy may help so long as baby remains in the upright position.
- Elevate the head of the cot so that baby is sleeping at a 30 degree tilt.
- If possible, never lie baby flatter than a 30 degree angle, even when changing a nappy.
- Avoid exposure to Tobacco smoke as it causes irritability.
- Avoid tight nappies or clothing especially around the abdomen
Management of GORD –Gastro Oesophageal Reflux Disease
There’s a few steps in the management of GORD. As there are many levels of GORD it’s worth remembering that every baby is different and what works for one baby may not have any effect on another baby. Your Health Practitioner will help you navigate through the different treatment options.
- Gaviscon or Carobel are Antacids that can be used to thicken formula feeds. The reason for thickening the formula is to help keep it in the stomach. You should always follow the dosage guidelines on the packet.
- A pre-thickened formula: These feeds have a built in thickener that starts to work when the formula is made up. Again the purpose of these feeds is to keep the formula in the tummy.
- Some babies may also require medication to reduce the amount of acid in the tummy. Your GP or Paediatrician will advise you on this.
- Breast Fed Babies may also have reflux. It is certainly possible to treat a breast fed baby but it is more of a challenge. When giving an antacid you should use a little expressed milk and add the antacid to this. Give it after the breast feed.
Infant Reflux Secondary to Cow’s Milk Protein Allergy
Although it’s important to follow the steps on the treatment ladder, it is also important to be aware that when baby’s reflux is not responding to treatment, the possibility of the reflux being secondary to a Cow’s Milk Protein Allergy (CMPA) must be considered. In this case, the reflux symptoms will be slow to improve while baby is still taking cow’s milk protein. And in fact, if the CMPA is treated early on, the symptoms improve and you may see a reduction in the reflux symptoms. As with all the digestive disorders, you may find that you will be treating more than one condition at a time but, with information and support, that’s very possible!
Cranial Osteopathy and Infant Reflux
Cranial Osteopathy, in a very gentle way, encourages the body’s tissues to release any tension and increases tissue flexibility. Reflux in my opinion challenges a number of key areas that support digestion. Firstly, the intestinal tract can become bloated and retain gas for longer periods. Secondly, the arching and extending associated with reflux can tension the breathing diaphragm as the baby is trying to ease their discomfort. Thirdly, as arching of the back persists, the neck musculature can also tension. Treatment applied to these key areas allows a gentle releasing of tension and lengthening of these tissues. This creates a more comfortable feeding process for the baby and eases the tissues supporting digestion.
Frank Kelleher Cranial Osteopath
Frank specialises in the treatment of babies and children, particularly digestive disorders in new-borns. He has 25 years’ experience in the Health Sector, both as a nurse for People with Learning Difficulties and an Osteopath. Frank’s wife Rose manages the clinic and is a nurse and a midwife. Frank works a little differently in that he has researched many of the conditions that affect babies, and as a result he has an in-depth knowledge of the treatment options available. Parents are given information and a management plan at their first visit and this is reviewed and adjusted if necessary at the follow up appointment.